Life-Saving Training Blog

 

When it Comes to Emergency Care and Safety, It’s About Teaching What Matters in the Moment

by  Bob Elling     Feb 5, 2024
paramedics_at_scene

In reviewing an instructor’s program recently, I had some time to reflect on a philosophy for developing training courses and materials for first responders. At the Emergency Care and Safety Institute (ECSI) deciding what to emphasize when developing training materials to educate first responders is a particularly important decision.

The ECSI philosophy is centered on “what matters in the moment.” That is, the moment(s) when responders are confronted with potential dangers, safety hazards, and threats to patient lives or limbs. Read to learn exactly what this means.

Applying Skills During Stressful Events

When under stress we react by doing what we know best. We have often referred to this level of training skills as developing “muscle memory” although some would argue connections are in your brain not your muscles.

Have you ever noticed that sometimes under the pressure of a skills exam or stressful field situation some experienced responders resort to previous skill techniques?

Ongoing research and consensus determine new Treatment Guidelines that dictates the need for a skill to be “updated.” Instructors need to understand that the older skill technique, which was practiced over and over many times, has been embedded (encoded) as procedural memory within the implicit area of the responder’s long-term memory. Implicit memory can be recalled automatically and as such considered the “muscle memory” which training programs strive to develop. In order for the instructor to help the experienced responder to deploy the latest version of the skill there are two steps that must be considered:

  • First, it is important for the responder to understand what has changed and why it has changed so they “buy into” the reasons for the change.
  • Second, the responder must proceed to practice the new technique many times to encode the new steps in long-term memory.

It is as if the responder needs to establish enough connections in the brain to cover up those previous pathways so when under stress they will automatically pull from the newly established implicit connections and not those old ones. Research has been done using brain MRI to illustrate the increases in connections or pathways from lots of practice.

Another way of looking at this would be to take one of the skills most of us learned as a child and have practiced thousands of times such as riding a bike. If you asked someone to write down the steps for riding a bike that could prove to be fairly complicated. Yet if you watched someone jump on their bike and ride down the street, hopefully with a helmet, those connections are well encoded in the implicit procedure area of long-term memory. Try asking the same person to then get on their bike and ride down the street but this time get on the bike from the other side. That might take a few extra moments!

So, if you see an experienced responder suddenly doing a “head-tilt neck-lift and then four quick breaths” it is likely under stress those new connections were not adequately developed. This concept has been referred to as the “blackboard effect” and suggests it is best to cover up the old technique. If they have not actually practiced the new method or steps, when under stress their brain will resort to the old information. The solution is to go back to the two steps listed above and do plenty of perfect practice!  Fortunately, new students may not have old versions of skills in their brain, but they will definitely need plenty of perfect practice to learn those skills that save lives!

What We Now Know

One key concept we learned from previous ILCOR science of education updates is that teaching too much content to our students can decrease their willingness and competence to respond to emergencies. Thus, the ECSI focus shifted to emphasize developing responder’s competency level and willingness to respond. The shift involved and continues to involve focusing on those things that really matter in a matter of moments as opposed to those things that matter in hours!

As instructors we need to draw attention to those things that really matter for our students/responders. We want them to remember the 1, 2, 3, or 4 things they should do that are critically important in an emergency and not spend so much time on detailed information they are most likely to forget or may confuse and delay their action.

We suggest instructors focus more on responding to critical emergencies when seconds count the most like:

  • Cardiac Arrest
  • Severe life-threatening Bleeding
  • Obstructed Airway
  • Anaphylactic Reactions

In these conditions a first responder’s immediate action can make a difference in outcome. The other injuries/diseases/conditions will still be in the textbooks but should not be the primary focus of the precious time you have with your students.

Tips on Improving Training Time

There is always lots to learn and that is why some seldom seen topics are covered in training materials but the priority for class-time should be safety, situational awareness and recognition and management of life and limb threats.

Face-to-face time in the classroom or skills lab is precious so use it wisely.  Come prepared with a plan for the training time, assistants well-prepped on the session's objectives, equipment in place and in working order, rotation and times figured out ahead of time.

With limited time, stay away from “ice breakers,” or war stories. Don’t spend course time on lengthy biographical introductions. If you want your students to know you have plenty of field experience and lots of “credentials,” write down your bio and include it in the course handouts for them to read (or not) as they wish on their time.

Emphasize safety and stress that responders need to have a practice ethic. It is what we do, often, to become better responders/providers. Everyone, including the most experienced responders, can benefit from practice, especially with the equipment and their team members.

Have your students demonstrate skill steps multiple times, perhaps teaching others in their group till they master the technique. Research has shown that breaks from the skills are also helpful as connections are made during the down time if you come back to the skills again in the next class or session.

View ECSI's Instructional Offerings

About the author:

Bob Elling, MPA, Paramedic (retired) – has been a career paramedic, educator, author, and EMS advocate since 1975. He was a paramedic with the Town of Colonie EMS Department, Albany Times Union Center, and Whiteface Mountain Medical Services. He was also an Albany Medical Center Clinical Instructor assigned to the Hudson Valley Community College Paramedic Program. Bob has served as National/Regional Faculty for the AHA and involved in many successful life-saving legislative campaigns with the You’re the Cure Network. He also served as paramedic and lieutenant for New York City EMS, a paramedic program director, and the associate director of New York State EMS Bureau. He has authored hundreds of articles, videos, and textbooks to prepare EMS providers for their career. Bob is the ECSI Medical Editor for the CPR and First Aid Series, Co-Author of EVOS, and Co-Lead Editor of Nancy Caroline’s Emergency Care in the Streets.

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When it Comes to Emergency Care and Safety, It’s About Teaching What Matters in the Moment

by  Bob Elling     Feb 5, 2024
paramedics_at_scene

In reviewing an instructor’s program recently, I had some time to reflect on a philosophy for developing training courses and materials for first responders. At the Emergency Care and Safety Institute (ECSI) deciding what to emphasize when developing training materials to educate first responders is a particularly important decision.

The ECSI philosophy is centered on “what matters in the moment.” That is, the moment(s) when responders are confronted with potential dangers, safety hazards, and threats to patient lives or limbs. Read to learn exactly what this means.

Applying Skills During Stressful Events

When under stress we react by doing what we know best. We have often referred to this level of training skills as developing “muscle memory” although some would argue connections are in your brain not your muscles.

Have you ever noticed that sometimes under the pressure of a skills exam or stressful field situation some experienced responders resort to previous skill techniques?

Ongoing research and consensus determine new Treatment Guidelines that dictates the need for a skill to be “updated.” Instructors need to understand that the older skill technique, which was practiced over and over many times, has been embedded (encoded) as procedural memory within the implicit area of the responder’s long-term memory. Implicit memory can be recalled automatically and as such considered the “muscle memory” which training programs strive to develop. In order for the instructor to help the experienced responder to deploy the latest version of the skill there are two steps that must be considered:

  • First, it is important for the responder to understand what has changed and why it has changed so they “buy into” the reasons for the change.
  • Second, the responder must proceed to practice the new technique many times to encode the new steps in long-term memory.

It is as if the responder needs to establish enough connections in the brain to cover up those previous pathways so when under stress they will automatically pull from the newly established implicit connections and not those old ones. Research has been done using brain MRI to illustrate the increases in connections or pathways from lots of practice.

Another way of looking at this would be to take one of the skills most of us learned as a child and have practiced thousands of times such as riding a bike. If you asked someone to write down the steps for riding a bike that could prove to be fairly complicated. Yet if you watched someone jump on their bike and ride down the street, hopefully with a helmet, those connections are well encoded in the implicit procedure area of long-term memory. Try asking the same person to then get on their bike and ride down the street but this time get on the bike from the other side. That might take a few extra moments!

So, if you see an experienced responder suddenly doing a “head-tilt neck-lift and then four quick breaths” it is likely under stress those new connections were not adequately developed. This concept has been referred to as the “blackboard effect” and suggests it is best to cover up the old technique. If they have not actually practiced the new method or steps, when under stress their brain will resort to the old information. The solution is to go back to the two steps listed above and do plenty of perfect practice!  Fortunately, new students may not have old versions of skills in their brain, but they will definitely need plenty of perfect practice to learn those skills that save lives!

What We Now Know

One key concept we learned from previous ILCOR science of education updates is that teaching too much content to our students can decrease their willingness and competence to respond to emergencies. Thus, the ECSI focus shifted to emphasize developing responder’s competency level and willingness to respond. The shift involved and continues to involve focusing on those things that really matter in a matter of moments as opposed to those things that matter in hours!

As instructors we need to draw attention to those things that really matter for our students/responders. We want them to remember the 1, 2, 3, or 4 things they should do that are critically important in an emergency and not spend so much time on detailed information they are most likely to forget or may confuse and delay their action.

We suggest instructors focus more on responding to critical emergencies when seconds count the most like:

  • Cardiac Arrest
  • Severe life-threatening Bleeding
  • Obstructed Airway
  • Anaphylactic Reactions

In these conditions a first responder’s immediate action can make a difference in outcome. The other injuries/diseases/conditions will still be in the textbooks but should not be the primary focus of the precious time you have with your students.

Tips on Improving Training Time

There is always lots to learn and that is why some seldom seen topics are covered in training materials but the priority for class-time should be safety, situational awareness and recognition and management of life and limb threats.

Face-to-face time in the classroom or skills lab is precious so use it wisely.  Come prepared with a plan for the training time, assistants well-prepped on the session's objectives, equipment in place and in working order, rotation and times figured out ahead of time.

With limited time, stay away from “ice breakers,” or war stories. Don’t spend course time on lengthy biographical introductions. If you want your students to know you have plenty of field experience and lots of “credentials,” write down your bio and include it in the course handouts for them to read (or not) as they wish on their time.

Emphasize safety and stress that responders need to have a practice ethic. It is what we do, often, to become better responders/providers. Everyone, including the most experienced responders, can benefit from practice, especially with the equipment and their team members.

Have your students demonstrate skill steps multiple times, perhaps teaching others in their group till they master the technique. Research has shown that breaks from the skills are also helpful as connections are made during the down time if you come back to the skills again in the next class or session.

View ECSI's Instructional Offerings

About the author:

Bob Elling, MPA, Paramedic (retired) – has been a career paramedic, educator, author, and EMS advocate since 1975. He was a paramedic with the Town of Colonie EMS Department, Albany Times Union Center, and Whiteface Mountain Medical Services. He was also an Albany Medical Center Clinical Instructor assigned to the Hudson Valley Community College Paramedic Program. Bob has served as National/Regional Faculty for the AHA and involved in many successful life-saving legislative campaigns with the You’re the Cure Network. He also served as paramedic and lieutenant for New York City EMS, a paramedic program director, and the associate director of New York State EMS Bureau. He has authored hundreds of articles, videos, and textbooks to prepare EMS providers for their career. Bob is the ECSI Medical Editor for the CPR and First Aid Series, Co-Author of EVOS, and Co-Lead Editor of Nancy Caroline’s Emergency Care in the Streets.

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